Provider Demographics
NPI:1154679488
Name:ANKUR MOHINDRA DDS, INC.
Entity Type:Organization
Organization Name:ANKUR MOHINDRA DDS, INC.
Other - Org Name:SMILEWORKS OF REDONDO BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-303-7930
Mailing Address - Street 1:1951 ARTESIA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2985
Mailing Address - Country:US
Mailing Address - Phone:310-303-7930
Mailing Address - Fax:310-303-7939
Practice Address - Street 1:1951 ARTESIA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2985
Practice Address - Country:US
Practice Address - Phone:310-303-7930
Practice Address - Fax:310-303-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty